Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1720 2nd Avenue South, UAB, Birmingham, AL, 35294-0016, USA.
J Gastrointest Surg. 2018 Feb;22(2):250-258. doi: 10.1007/s11605-017-3514-y. Epub 2017 Jul 28.
Conflicting data exist on racial disparities in stoma reversal (SR) rates. Our aim was to investigate the role of race in SR rates, and time to closure, in a longitudinal, racially diverse database.
All adult patients (>18 years) who received an ileostomy or colostomy from 1999 to 2016 at a single institution were identified. Primary outcomes were SR rates and time to closure. Failure to reverse and time to closure was modeled using Cox regression. Kaplan-Meier survival curves, stratified by race, were generated for time to closure and hazard ratios (HRs) calculated.
Of 770 patients with stomas, 65.6% of patients underwent SR; 76.6% were white and 23.4% were black. On adjusted analysis, race did not predict overall SR rates or time to closure if performed less than 1 year. Instead, significant predictors for failure in SR included age, insurance status, end colostomy/ileostomy, and loop colostomy (p < 0.05). Predictors of delay in time to closure included insurance, end colostomy/ileostomy, and loop colostomy (p < 0.05). In patients who underwent reversal after 1 year, black race was an independent predictor of time to closure (HR 0.21, 95% CI 0.07-0.63, p < 0.05).
SR rates were equal between black and white patients. Disparities in time to closure existed only for black patients if reversed more than 1 year after index stoma construction. While equitable outcomes were achieved for most patients, further investigation is necessary to understand stoma disparities after 1 year.
种族间在造口反转（SR）率方面存在差异，相关数据相互矛盾。我们旨在通过一个种族多样化的纵向数据库来调查种族在 SR 率和关闭时间中的作用。
在一个单一机构中，对 1999 年至 2016 年间接受回肠造口术或结肠造口术的所有成年患者（>18 岁）进行了识别。主要结果是 SR 率和关闭时间。采用 Cox 回归模型对失败的反转和关闭时间进行建模。生成按种族分层的关闭时间 Kaplan-Meier 生存曲线，并计算危险比（HR）。
在 770 例有造口的患者中，65.6%的患者进行了 SR；76.6%是白人，23.4%是黑人。在调整分析中，如果在 1 年内进行 SR，种族并不能预测总体 SR 率或关闭时间。相反，SR 失败的显著预测因素包括年龄、保险状况、结肠造口/回肠造口和环型结肠造口（p<0.05）。关闭时间延迟的预测因素包括保险、结肠造口/回肠造口和环型结肠造口（p<0.05）。在 1 年后进行反转的患者中，黑人种族是关闭时间的独立预测因素（HR 0.21，95%CI 0.07-0.63，p<0.05）。
黑人患者和白人患者的 SR 率相等。只有在索引造口术后 1 年以上进行反转时，黑人患者的关闭时间才存在差异。虽然大多数患者的结果是公平的，但需要进一步研究以了解 1 年后的造口差异。
